Provider First Line Business Practice Location Address:
104 S FREYA
Provider Second Line Business Practice Location Address:
WHITE FLAG BLDG SUITE 120B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-979-9830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007